- What is cervical cancer?
- What are the risk factors for cervical cancer?
- Signs and symptoms of cervical cancer
- Can cervical cancer be prevented?
- The American Cancer Society guidelines for the prevention and early detection of cervical cancer
- The HPV DNA test
- The Pap (Papanicolaou) test
- Work-up of abnormal Pap test results
- How women with abnormal Pap test results or pre-cancers are treated
- Cervical cancer prevention and screening: Financial issues
- Additional resources
Can cervical cancer be prevented?
Since the most common form of cervical cancer starts with pre-cancerous changes, there are 2 ways to stop this disease from developing. One way is to find and treat pre-cancers before they become true cancers, and the other is to prevent the pre-cancers in the first place.
Finding cervical pre-cancers
A well-proven way to prevent cervix cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (sometimes called the Pap smear) and the HPV (human papilloma virus) test are used for this. If a pre-cancer is found, it can be treated, stopping cervical cancer before it really starts. Since no HPV vaccine provides complete protection against all of the HPV types that can cause cancer of the cervix, it cannot prevent all cases of cervical cancer. This is why it is very important that women continue to have cervical cancer screening even after they’ve been vaccinated. Most invasive cervical cancers are found in women who have not had regular screening.
See the section, “The American Cancer Society guidelines for the prevention and early detection of cervical cancer” for more details.
Things to do to prevent pre-cancers and cancers
Avoid contact with the human papilloma virus (HPV)
Since HPV is the main cause of cervical cancer and pre-cancer, avoiding exposure to HPV could help you prevent this disease. HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. Although HPV can be spread during sex − including vaginal, anal, and oral sex − sex doesn't have to occur for the infection to spread. All that is needed is skin-to-skin contact with an area of the body infected with HPV. This means that the virus can be spread through genital-to-genital contact (without intercourse). It is even possible for a genital infection to spread through hand-to-genital contact.
Also, HPV infection seems to be able to be spread from one part of the body to another. This means that an infection may start in the cervix and then spread to the vagina and vulva.
It can be very hard not to be exposed to HPV. It may be possible to prevent genital HPV infection by not allowing others to have contact with your anal or genital area, but even then there might be other ways to become infected that aren’t yet clear. For example, a recent study found HPV on the surface of sex toys, so sharing sex toys might spread HPV.
HPV infection in women: HPV infections occur mainly in younger women and are less common in women older than 30. The reason for this is not clear. Certain types of sexual behavior increase a woman's risk of getting HPV infection, such as having sex at an early age and having many sex partners.
Women who have had many sex partners are more likely to get infected with HPV, but a woman who has had only one sex partner can still get infected. This is more likely if she has a partner who has had many sex partners or if her partner is an uncircumcised male.
Waiting to have sex until you are older can help you avoid HPV. It also helps to limit your number of sex partners and to avoid having sex with someone who has had many other sex partners. Although the virus most often spreads between a man and a woman, HPV infection and cervical cancer also are seen in women who have only had sex with other women. Remember that someone can have HPV for years and still have no symptoms − it does not always cause warts or other problems. Someone can have the virus and pass it on without knowing it.
Still, since all that’s needed to pass HPV from one person to another is skin-to-skin contact with an area of the body infected with HPV, even never having sex doesn’t guarantee that you won’t ever get infected. It might be possible to prevent anal and genital HPV infection by never allowing another person to have contact with those areas of your body.
HPV infection in men: For men, the main factors influencing the risk of genital HPV infection are circumcision and the number of sex partners.
Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of becoming and staying infected with HPV. Men who have not been circumcised are more likely to be infected with HPV and pass it on to their partners. The reasons for this are unclear. It may be that after circumcision the skin on the glans (of the penis) goes through changes that make it more resistant to HPV infection. Another theory is that the surface of the foreskin (which is removed by circumcision) is more easily infected by HPV. Still, circumcision does not completely protect against HPV infection − men who are circumcised can still get HPV and pass it on to their partners.
The risk of being infected with HPV is also strongly linked to having many sexual partners (over a man's lifetime).
Condoms (“rubbers”) provide some protection against HPV but they don’t completely prevent infection. Men who use condoms are less likely to be infected with HPV and to pass it on to their female partners. One study found that when condoms are used correctly every time sex occurs they can lower the HPV infection rate by about 70%. One reason that condoms cannot protect completely is because they don’t cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also protect against HIV and some other sexually transmitted infections. Condoms (when used by the male partner) also seem to help the HPV infection and cervical pre-cancers go away faster.
Female condoms fit inside the vagina and can help protect against pregnancy. They also can protect against sexually transmitted infections, including HPV and HIV, although for this they aren’t as effective as male condoms.
Not smoking is another important way to reduce the risk of cervical pre-cancer and cancer.
Two vaccines are available that can protect women from certain HPV infections. One of these, Gardasil®, protects against HPV types 6, 11, 16 and 18. The other, Cervarix®, protects against types 16 and 18. Both vaccines require a series of 3 injections over a 6-month period.
Side effects are usually mild. The most common one is short-term redness, swelling, and soreness at the injection site. Rarely, a young woman will faint shortly after the vaccine injection.
Both vaccines help prevent pre-cancers and cancers of the cervix caused by HPV types 16 and 18. Gardasil can also help prevent anal, vaginal, and vulvar cancers caused by those HPV types, as well as genital warts caused by HPV types 6 and 11. Cervarix also provides some protection against infection and pre-cancers of the cervix caused by high-risk HPV types other than HPV 16 and 18. It can also help prevent anal infection from HPV types 16 and 18.
Both vaccines only work to prevent HPV infection − they will not treat an infection that is already there. That is why, to be most effective, the HPV vaccine should be given before a person becomes exposed to HPV (such as through sexual activity).
The Federal Advisory Committee on Immunization Practices (ACIP) recommends that females aged 11 to 12 routinely be vaccinated for HPV with the full series of 3 shots. Females as young as age 9 may also receive the HPV vaccine at the discretion of their doctors. ACIP also recommended women ages 13 to 26 who have not yet been vaccinated get “catch-up” vaccinations. Either vaccine may be used to prevent cervical cancers and pre-cancers. However, the ACIP recommends using Gardasil to prevent genital warts as well as cervical cancers and pre-cancers.
These vaccines have been tested in women over 26, and do seem to be effective in producing an immune reaction to the HPV types in the vaccine and also reduce cervical cancers and pre-cancers in those vaccinated. But the overall benefit in this age group was small, and so they have not been approved by the FDA for use in women over 26. Studies in males have shown that Gardasil can prevent anal cancers and pre-cancers as well as anal and genital warts in men, and it has also been approved by the FDA for that use.
The American Cancer Society also recommends that the HPV vaccine be routinely given to girls ages 11 to 12 and as early as age 9 at the discretion of doctors. The Society also agrees that “catch-up” vaccinations should be given to females up to age 18. The independent panel making the Society recommendations found that there was not yet enough proof that catch-up vaccinations for all women aged 19 to 26 years would be beneficial. As a result, the American Cancer Society recommends that women aged 19 to 26 talk with their health care provider about their risk of previous HPV exposure and potential benefit from vaccination before deciding to get the vaccine. At this time, the American Cancer Society’s guidelines do not address the use of the vaccine in older women or males.
It’s important to realize that neither vaccine provides complete protection against all cancer-causing types of HPV, so routine cervical cancer screening is still necessary.
For more information on the vaccine and HPV, please see our document, HPV Vaccines.
Last Medical Review: 09/17/2014
Last Revised: 10/16/2014